Create Business Account

Please enter your information and then submit the form to create your new account.

Business Information

Type of Speciality

Additional Information

A current and valid copy of your State License needs to be filled out to purchase medicine or some medical supplies due to Federal Regulations. We will set up your account permission after receiving your license information. If you have any questions, please contact your account manager or call our Customer Service number at (347) 754-6888.